Canine Infectious Diseases: Self-Assessment Color Review, Q&A 19

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Student tip: This case is an example of good use of image and history.

A 1-year-old neutered female Poodle was evaluated for a 6-month history of intermittent cough and gagging episodes that did not coincide with eating, drinking, or exercise. These episodes persisted for weeks at a time and were sometimes accompanied by lethargy and inappetence. The dog lived in Sacramento, California, USA, had received her basic vaccination series, and was on heartworm prophylaxis; she had been neutered at around 6 months of age. A local veterinarian had examined the dog and a lateral thoracic radiograph had been obtained (see image). The dog had been treated with one course of 7 days of amoxicillin–clavulanic acid but the cough had not improved. On physical examination, the temperature was 39.1°C (102.4°F), pulse 124 bpm, respiratory rate 32 breaths/min, and spontaneous coughing occurred throughout the examination. Normal bronchovesicular lung sounds were present in all lung fields and a cough was easily elicited on tracheal palpation. The remainder of the physical examination was normal.

Question	Answer		Article
What is your interpretation of the radiograph?	The thoracic radiograph shows normal cardiopulmonary structures.		Link to Article
What differential diagnoses should you consider?	Given the age and breed of this patient, the top differential diagnoses are tracheal collapse and canine infectious respiratory disease complex (CIRD), although the course of illness is long for the latter condition. Occasionally, bordetellosis or mycoplasmosis can be associated with a chronic cough that lasts weeks to months, but this is unusual. The owners should be questioned about whether the onset of cough followed intubation for the spay operation and should be asked about exposure to other dogs that are coughing.		Link to Article
What additional diagnostic tests should be performed?	A CBC could be considered, although it is unlikely to be abnormal if the patient has only local (i.e. tracheal) inflammation. Fluoroscopy would be valuable to investigate the possibility of airway collapse. Given the long duration of the history, the owners should be encouraged to pursue bronchoscopy and bronchoalveolar lavage. A short course of doxycycline could be considered for treatment of bordetellosis or mycoplasmosis		Link to Article

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